World's first robotic surgery to remove kidney cancer spread in the heart

Bee Kee Ng, 29 Apr 2017

Mark Cunningham and Inderbir Gill led the multidisciplinary team that performed the surgery. Photo credit: Ricardo Carrasco and Van Urfalian/USC

Since 2014, Keck School of Medicine of University of South California (USC) has been recognised as the first medical centre in the world to use advanced robotic technology in procedures for kidney cancer patients.

The surgical team led by Inderbir Gill, professor of urology and associate dean of clinical innovation at the Keck School of Medicine of USC, completed the first complex kidney cancer operation using daVinci Xi robot.

This year, the multidisciplinary surgical team has performed the world’s first robotic, minimally invasive surgical removal of a kidney cancer tumour that extends into the heart, achieving another medical breakthrough.

“This exciting feat promises to redefine the boundaries of what is surgically possible through skill, collaboration and technology,” said Gill.

Patient saved from risk of sudden death

According to the American Cancer Society, approximately 64,000 new cases of kidney cancer are diagnosed every year. Only about 10% of the patients have cancer that spreads through the blood vessels, and a small portion of them risk from sudden death when the kidney cancer extends through the vena cava into the heart.

In general, the surgery for a stage IV tumour thrombus, or blood clot, is both risky and traumatic because it requires major open surgery. However, with the minimally invasive technique, such risks were avoided.

Caption: Animated 3-D imaging of the patient’s organs was used to plan the complex procedure. Image credit: Inderbir Gill/USC

The procedure took nearly 10 hours, which required painstaking precision from three renowned surgeons, a radiologist and a critical care anaesthesiologist. The surgery successfully reduced the patient’s risk of sudden death from the tumour breaking off into the heart and lungs.

With the help of robotic surgery techniques, the trauma of the patient was greatly reduced and the blood loss was minimised by more than five-fold. After an open surgery, patients would usually need to stay in the hospital for two to three weeks. However, the patient only required a short hospital stay of six days and showed a fast recovery rate.

“Our hope is that we can now propel the field at large to turn such futuristic robotic surgery into our present standard-of-care,” said Gill.

Coordination among experts were vital

Prior the surgery, Vinnay Duddalwar, associate professor of clinical radiology, created 3D maps of the patient’s chest and abdomen to allow the surgeons to pre-plan their strategy in millimetre precision. Following that, Namir Katkhouda, professor of the surgery, performed a surgical manoeuvre to control blood flow to the patient’s liver.

The procedure was followed by Gill dissecting the tumour-bearing kidney using the latest-generation daVinci Xi robot and accessing the inferior vena cava where the cancer had spread. Next, Mark Cunningham, associate professor of surgery, inserted a heart-lung bypass machine on the patient to create a bloodless environment for tumour removal.

Hence, Gill and Cunningham worked together to remove the tumour thrombus from the heart and the inferior vena cava respectively. Throughout the surgery, Duraiyah Thangathurai, professor of clinical anesthesiology and chief of critical care medicine, was monitoring the patient’s organ function to ensure the procedure went smoothly. MIMS